Humana Notification of payment policy and code-editing updates

Humana has posted a policy/coding update that will take effect on 9/14/2015:

http://apps.humana.com/marketing/documents.asp?file=2642614

Unless otherwise noted below, these updates will be applicable across all of Humana’s product lines (commercial & Medicare):

1. Humana addresses maximum dosages/acceptable diagnosis codes for several drugs & biologicals. Please reference the guide to determine if any of the updates pertain to services provided in your practice.
2. Ambulatory EEG: This service will only be eligible for reimbursement when provider has billed a resting EEG for the same patient on that same day or within the last 12 months.
3. Modifier 78: Humana will utilize the CMS payment policies for services billed with Modifier -78 (unplanned return to operating room).
4. Telehealth:  Humana Medicare beneficiaries are not eligible for telehealth services billed with a -GQ modifier.
5. New Services Added to Multiple Procedure Payment Reduction (MPPR) Set:
6. 51725
7. 51726
8. 51727
9. 51728
10. 51729
11. 51741
12. 51784
13. 51785
14. 51792
15. 93455
16. Maternity Care & Delivery-Antepartum, Delivery & Postpartum: Urinalysis will no longer be separately reimbursed when submitted with a diagnosis indicating pregnancy.